Provider Demographics
NPI:1710658042
Name:EBERT, TAYLER ROBIN (APRN FNP-C)
Entity Type:Individual
Prefix:MS
First Name:TAYLER
Middle Name:ROBIN
Last Name:EBERT
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:TAYLER
Other - Middle Name:ROBIN
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1403
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-1403
Mailing Address - Country:US
Mailing Address - Phone:229-548-3919
Mailing Address - Fax:229-242-6087
Practice Address - Street 1:4274 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6814
Practice Address - Country:US
Practice Address - Phone:229-242-1234
Practice Address - Fax:229-242-0687
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN215464OtherGEORGIA BOARD OF NURSE APRN LICENSE NUMBER
F08211302OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION NUMBER